News & Analysis as of

Employee Retirement Income Security Act (ERISA) › Health Insurance › Denial of Benefits

Haynes Boone

A Plan Document a Day Keeps the Physician Lawsuits Away

Haynes Boone on

Physicians generally do not have direct standing to bring a claim for benefits under an ERISA group health plan. Rather, a physician’s standing derives from the patient’s status as a plan participant and must be assigned....more

Littler

Fourth Circuit Establishes New Standards for Plaintiffs Seeking Unjust Enrichment as an Equitable Remedy under ERISA

Littler on

The United States Court of Appeals recently shed light on when—and under what conditions—a plaintiff may seek a monetary recovery under § 502(a)(3) of the Employee Retirement Income Security Act (ERISA). Section 502(a)(3)...more

Troutman Pepper Locke

Courts Continue to Scrutinize ERISA Health Plan Benefit Denial Letters

Troutman Pepper Locke on

As discussed here, administrators’ health plan benefit denial letters have recently been under scrutiny by the courts. For example, in D.K. et al. v. United Behavioral Health et al., the Tenth Circuit is reviewing a district...more

Robinson+Cole ERISA Claim Defense Blog

Second Circuit Clarifies That Reclassification of Health Status That Limits Scope of Disability Benefits Does Not Constitute...

Robinson+Cole ERISA Claim Defense Blog on

In Ruderman v. Liberty Mut. Grp., Inc., No. 21-817, 2022 WL 244086 (2d Cir. Jan. 27, 2022), the U.S. Court of Appeals for the Second Circuit ruled that reclassification of a claimant’s disability from one that is...more

Rivkin Radler LLP

Employee Benefit Plan Review – From the Courts

Rivkin Radler LLP on

Second Circuit Affirms Decision Rejecting ERISA Claims for Retiree Health Benefits The U.S. Court of Appeals for the Second Circuit has affirmed a district court’s decision dismissing claims under the Employee Retirement...more

Robinson+Cole ERISA Claim Defense Blog

Remand Directing Change in Standard of Judicial Review Is Not Sufficient Success on the Merits to Support Attorneys’ Fee Award

Robinson+Cole ERISA Claim Defense Blog on

In Ariana M. v. Humana Health Plan of Texas, Inc., No. 18-20700, 2019 WL 5866677 (5th Cir. Nov. 8, 2019), the Fifth Circuit Court of Appeals rejected a plaintiff’s petition for attorneys’ fees under 29 U.S.C. § 1132(g).  This...more

Dickinson Wright

Highlights from Wit v. United Behavioral Health

Dickinson Wright on

Earlier this month, on March 5, 2019, the United States District Court in the Northern District of California filed its 106-page Findings of Fact and Conclusions of Law in the class action Wit v. United Behavioral Health...more

Spilman Thomas & Battle, PLLC

Careful, Careful: Arbitration of Benefit Claims Under Collective Bargaining Agreements

Spilman Thomas & Battle, PLLC on

In Cup v. Ampco Pittsburgh Co., 2018 WL 4101049 (3rd Cir. Aug. 29, 2018), the Third Circuit addressed a case concerning the arbitrability of benefit claims by retirees in the context of collective bargaining agreements...more

Seyfarth Shaw LLP

Ninth Circuit Holds that ERISA Preempts State Insurance Law Bans on Discretionary Clauses for Self-Funded ERISA Plans

Seyfarth Shaw LLP on

Seyfarth Synopsis: The Ninth Circuit Court of Appeals recently confirmed that ERISA preempts state insurance law bans on discretionary clauses for self-funded ERISA plans....more

Seyfarth Shaw LLP

Court Smacks Down Plaintiff’s “[But Mom…] Everyone Else Is Doing It” Public Policy Argument To Void Illegal Exclusions Provisions

Seyfarth Shaw LLP on

Seyfarth Synopsis: A Court ruled that under the Affordable Care Act, an ERISA governed plan exclusion cannot unequivocally bar emergency medical care related to injuries sustained in a fireworks explosion. Recently, a...more

BakerHostetler

Texas Surgical Centers: Aetna Improperly Denies or Underpays Out-of-Network Claims

BakerHostetler on

Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On September 4, 2015, six surgical centers in Texas (Allied Center for Special...more

Foley & Lardner LLP

Second Circuit Reinstates Mental Health Parity Case Against UnitedHealth

Foley & Lardner LLP on

In late August the U.S. Court of Appeals for the Second Circuit reinstated a lawsuit by a physician association against a third-party plan administrator. The case against UnitedHealth Group and related entities (United) had...more

McDermott Will & Emery

Seventh Circuit Finds that State Insurance Law Applies, Resulting in De Novo Review of Benefit Claim

McDermott Will & Emery on

On September 4, 2015, the U.S. Court of Appeals for the Seventh Circuit ruled in Fontaine v. Metropolitan Life Insurance Company that the Employee Retirement Income Security Act of 1974, as amended (ERISA), does not preempt...more

13 Results
 / 
View per page
Page: of 1

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up Log in
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide